Vaginal bleeding

Last updated: Thursday, 17, February, 2011

Causes	Appropriate Tests
	Diagnosis based on clinical assessment, including: age of patient, sexual activity, and relationship of bleeding to menstrual cycle. Consider possibility of miscarriage of pregnancy (including ectopic) in any woman of child bearing age. See under Abortion and Ectopic pregnancy Cervical cytology in all sexually active patients, and in all patients over 25 years of age. FBC, blood film if bleeding heavy and/or prolonged. See Iron deficiency See also Vaginal discharge
Menorrhagia
Uterine/cervical abnormalities, especially Fibroids Polyps Adenomyosis Endometriosis Endometrial hyperplasia Carcinoma	Endometrial biopsy (curettage). Lesion biopsy if appropriate.
High, unopposed endogenous oestrogen levels Polycystic ovary syndrome Ovarian tumours	See Ovarian mass
Other disorders Renal failure Hypothyroidism Cirrhosis
Dysfunctional bleeding	Common; diagnosis of exclusion.
Bleeding disorder	See under Bleeding disorder
Post-coital, intermenstrual bleeding	Endometrial biopsy (curettage); lesion biopsy if appropriate.
Cervical abnormalities, especially Cervical ectropion Cervicitis Carcinoma	See Cervical lesion
Oral contraceptives, especially Progesterone-only preparations
Uterine abnormalities Fibroids Intra-uterine contraceptive device Carcinoma
Vaginal abnormalities, including Retained tampon	See also Vaginal discharge
Post-menopausal bleeding	Hysteroscopic examination and endometrial biopsy; lesion biopsy if appropriate.
Uterine/cervical abnormalities, especially Carcinoma Sarcoma Polyps Atrophic change